Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups

May combine two claims.

Methods for including qualitative and quantitative evidence in systematic reviews developed by the EPPI Centre have involved refinements and extensions of conventional systematic review methodology and have limited their application of interpretive techniques to synthesis of qualitative evidence.

“Methods for including qualitative and quantitative evidence in systematic reviews developed by the EPPI Centre at the Institute of Education, London, have involved refinements and extensions of conventional systematic review methodology [6-8], and have limited their application of interpretive techniques to synthesis of qualitative evidence.”

• cites [6] Shepherd J, Harden A, Rees R, Brunton G, Garcia J, Oliver S, Oakley A: Young people and healthy eating: a systematic review of research on barriers and facilitators. Health Educ Res. 2006, 21: 239-257. 10.1093/her/cyh060. sourceNot checked — no full text of the source
• cites [7] Harden A, Garcia J, Oliver S, Rees R, Shepherd J, Brunton G, Oakley A: Applying systematic review methods to studies of people's views: an example from public health research. J Epidemiol Community Health. 2004, 58: 794-800. 10.1136/jech.2003.014829. sourceDisputed

  Split into 2 atoms — 1 confirmed, 0 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured
• cites [8] Thomas J, Harden A, Oakley A, Oliver S, Sutcliffe K, Rees R, Brunton G, Kavanagh J: Integrating qualitative research with trials in systematic reviews. BMJ. 2004, 328: 1010-1012. 10.1136/bmj.328.7446.1010. sourceSupported

May combine two claims.

We piloted the use of a highly structured search strategy using protocol-driven searches across a range of electronic databases but found that was unsatisfactory.

“We piloted the use of a highly structured search strategy using protocol-driven searches across a range of electronic databases but, like Greenhalgh and Peacock [17] found that was this unsatisfactory.”

• cites [17] Greenhalgh T, Peacock R: Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources. BMJ. 2005, 331: 1064-1065. 10.1136/bmj.38636.593461.68. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

How or whether to appraise papers for inclusion in an interpretive review has received a great deal of attention, but there is little sign of an emergent consensus.

“How or whether to appraise papers for inclusion in an interpretive reviews has received a great deal of attention, but there is little sign of an emergent consensus [22].”

• cites [22] Dixon-Woods M, Shaw RL, Agarwal S, Smith JA: The problem of appraising qualitative research. Qual Saf Health Care. 2004, 13: 223-225. 10.1136/qshc.2003.008714. sourcePartly supported

  The Abstract says that proposals for appraising qualitative research show few signs of consensus, and the introduction discusses disagreement over whether quality criteria should exist. The introduction also says quality assessments are needed for reviews. The paper does not specifically address appraisal for inclusion in interpretive reviews, so the claim is more specific than the source. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

There is significant evidence of lower use of preventive services among more deprived groups, as well as evidence of higher use of accident and emergency facilities, emergency admissions and out-of-hours use.

“There is significant evidence of lower use of preventive services among more deprived groups, [33,34] as well as evidence of higher use of accident and emergency facilities, emergency admissions and out-of-hours use [35,35,37,38].”

• cites [33] Martin R, Sterne J: Social and economic variation in general practice consultation rates amongst men aged 16–39. Health Statistics Quarterly. 2001, 09: 29-36.Not checked — no full text of the source
• cites [34] Watt G: The inverse care law today. Lancet. 2002, 360: 252-254. 10.1016/S0140-6736(02)09466-7. sourceNot checked — no full text of the source
• cites [35] Majeed F, Cook D, Hilton S, Poloniecki J, Hagen A: Annual night visiting rates in 129 general practices in one family health services authority: Association with patient and general practice characteristics. Br J Gen Pract. 1995, 45: 531-535.Not checked — no full text of the source
• cites [37] Blatchford O, Capewell S, Murray S, Blatchford M: Emergency medical admissions in Glasgow: general practices vary despite adjustment for age, sex, and deprivation. Br J Gen Pract. 1999, 49: 551-554.Not checked — no full text of the source
• cites [38] Carlisle R, Groom L, Avery A, Boot D, Earwicker S: Relation of out-of-hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal survey. BMJ. 1998, 316: 520-523. sourcePartly supported

  The Out of hours activity section reports that higher deprivation scores were associated with higher out-of-hours rates for both general practice and accident and emergency services. The cited paper does not establish higher emergency admissions; the preventive-services claim is attached to different citations. Page numbers are unavailable in our copy. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Doctors' practices are often exercised through a repertoire of routine judgements about the possibilities presented by individual patients and the routinely available means of solving these.

“May et al's [60] analysis suggests doctors' practices are often exercised through a repertoire of routine judgements about the possibilities presented by individual patients and the routinely available means of solving these.”

• cites [60] May C, Allison G, Chapple A, Chew-Graham C, Dixon C, Gask L, Graham R, Rogers A, Roland M: Framing the doctor-patient relationship in chronic illness: a comparative study of general practitioners' accounts. Sociol Health Illn. 2004, 26: 135-158. 10.1111/j.1467-9566.2004.00384.x. sourceSupported

May combine two claims.

Patients can resist being referred and can resist offers of medication.

“Referral implies that a GP has identified particular features of candidacy and is seeking to match those to a service that deals with that form of candidacy, but patients can resist being referred [42,63] and can resist offers of medication [64,65].”

• cites [42] Gardner K, Chapple A: Barriers to referral in patients with angina: qualitative study. BMJ. 1999, 319: 418-421. sourceSupported
• cites [63] Fuat A, Hungin A, Murphy J: Barriers to accurate diagnosis and effective management of heart failure in primary care: qualitative study. BMJ. 2003, 326: 196-200. 10.1136/bmj.326.7382.196. sourceSupported
• cites [64] Britten N, Stevenson F, Gafaranga J, Barry C, Bradley C: The expression of aversion to medicines in general practice consultations. Soc Sci Med. 2004, 59: 1495-1503. 10.1016/j.socscimed.2004.01.019. sourceNot checked — no full text of the source
• cites [65] Scahfheutle E, Hassell K, Noyce P, Weiss M: Access to medicines: cost as an influence on the views and behaviour of patients. Health Soc Care Community. 2002, 10: 187-195. 10.1046/j.1365-2524.2002.00356.x. sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

For our project, it was neither possible nor desirable to specify in advance the precise review question, a priori definitions, or categories under which the data could be summarised.

“For our project, it was neither possible nor desirable to specify in advance the precise review question, a priori definitions, or categories under which the data could be summarised”

• AssumptionRests on an assumption: The groups defined by the funders (children, older people, members of minority ethnicities, men/women, and socio-economically disadvantaged people) are potentially vulnerable groups for access to NHS healthcare.

May combine two claims.

By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting critical interpretive synthesis, but also a new theoretical conceptualisation of access to healthcare.

“By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical interpretive synthesis, but also a new theoretical conceptualisation of access to healthcare.”

May combine two claims.

Searching generated thousands of potentially relevant items - at one stage over 100,000 records.

“However, searching generated thousands of potentially relevant items – at one stage over 100,000 records.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Our sampling frame eventually totalled approximately 1,200 records.

“Our sampling frame eventually totalled approximately 1,200 records.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Early analytic categories were tentative and contingent, but gradually became firmed up and more highly specified as our analysis continued.

“Early analytic categories were tentative and contingent, but gradually became firmed up and more highly specified as our analysis continued.”

Classified as probably not a substantial claim.

Our synthesis involved the generation of a synthesising argument that has the synthetic construct of candidacy at its core.

“It further involved the generation of a synthesising argument that has the synthetic construct of candidacy at its core.”

Classified as probably not a substantial claim.

Our experiences of working with a large sample of papers using multiple methods led us to refine and respecify some of the concepts and techniques of meta-ethnography in order to enable synthesis of a very large and methodologically diverse literature.

“Our experiences of working with a large sample of papers using multiple methods led us to refine and respecify some of the concepts and techniques of meta-ethnography in order to enable synthesis of a very large and methodologically diverse literature.”

Probably not a substantial claim: may not pass S3 (load-bearing).

It proved impossible to conduct this form of data extraction on all documents included in the review, including very large documents.

“Practically, however, it proved impossible to conduct this form of data extraction on all documents included in the review, including very large documents.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Our approach does not make this precise distinction between second and third order constructs.

“In effect, therefore, our approach does not make this precise distinction between second and third order constructs.”

Classified as probably not a substantial claim.

Our synthesis involved a critique of the tendency to use measures of utilisation as a means of assessing the extent to which access to healthcare is equitable.

“Our synthesis involved a critique of the tendency to use measures of utilisation as a means of assessing the extent to which access to healthcare is equitable.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Our analysis of the evidence, in order to produce a synthesising argument, was similar to that undertaken in primary qualitative research.

“Our analysis of the evidence, in order to produce a synthesising argument, was similar to that undertaken in primary qualitative research.”

Classified as probably not a substantial claim. May combine two claims.

In our review, some methodologically weak papers were important in terms of their theoretical contribution, or in terms of demonstrating the breadth of evidence considered in the construction of particular categories, or in terms of providing a more comprehensive summary of the evidence, while a single strong paper might be pivotal in the development of the synthesis.

“Thus, in our review, some methodologically weak papers were important in terms of their theoretical contribution, or in terms of demonstrating the breadth of evidence considered in the construction of particular categories, or in terms of providing a more comprehensive summary of the evidence, while a single strong paper might be pivotal in the development of the synthesis.”

May combine two claims.

A small body of recent research has identified local influences on the production of candidacy, and in our analysis these are hugely important.

“A small body of recent research has identified what might be called local influences on the production of candidacy, and in our analysis these are hugely important.”

Classified as probably not a substantial claim.

Hughes and Griffiths' paper on micro-rationing of healthcare was a key paper in helping to generate the construct of candidacy that later came to unify the themes of our analysis.

“Hughes and Griffiths' paper on micro-rationing of healthcare [61], for example, was a key paper in helping to generate the construct of candidacy that later came to unify the themes of our analysis.”

• cites [61] Hughes D, Griffiths L: Ruling in and Ruling out: two approaches to the micro-rationing of health care. Soc Sci Med. 1997, 44: 589-599. 10.1016/S0277-9536(96)00207-9. sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

The conceptual model of access that we developed emphasises candidacy as the core organising construct, and recasts access as highly dynamic and contingent, and subject to constant negotiation.

“The conceptual model of access that we developed emphasises candidacy as the core organising construct, and recasts access as highly dynamic and contingent, and subject to constant negotiation.”

Classified as probably not a substantial claim.

In addition to the core construct of candidacy, our analysis required the production of a number of other linked synthetic constructs, including adjudications and offers.

“In addition to the core construct of candidacy, our analysis required the production of a number of other linked synthetic constructs – constructs generated through an attempt to summarise and integrate diverse concepts and data – including “adjudications” and “offers”.”

Classified as probably not a substantial claim.

The CIS approaches adopted deferred final definition of the phenomenon of access and the appropriate ways of conceptualising it until the analysis was complete.

“The CIS approaches we adopted deferred final definition of the phenomenon of access and the appropriate ways of conceptualising it until our analysis was complete.”

Classified as probably not a substantial claim.

Our critique of the current literature focused on the inadequacies of studies of utilisation as a guide to explaining inequities in health care.

“Our critique of the current literature focused on the inadequacies of studies of utilisation as a guide to explaining inequities in health care.”

May combine two claims.

Candidacy of socially disadvantaged people appears to be at risk of being judged to be less eligible, at least for some types of interventions, although the evidence that this happens is not particularly strong.

“Candidacy of socially disadvantaged people appears to be at risk of being judged to be less eligible, at least for some types of interventions, although the evidence that this happens is not particularly strong.”

Classified as probably not a substantial claim.

The methods for review developed in this project built on conventional systematic review methodology in their sensitivity to the need for attentiveness to a range of methodological processes.

“The methods for review that we developed in this project (Table 2) built on conventional systematic review methodology in their sensitivity to the need for attentiveness to a range of methodological processes.”

Classified as probably not a substantial claim.

It was possible to link existing second order constructs, for example relating to help-seeking as the identification of candidacy by patients, into the synthesising argument, and make these work as synthesising constructs.

“It was also possible to link existing “second order” constructs, for example relating to help-seeking as the identification of candidacy by patients, into the synthesising argument, and making these work as synthesising constructs.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The final version of the conceptual model of access to healthcare that we eventually developed did not emerge until quite late in the review process, and much of the later sampling was directed at testing and purposively challenging the theory as we began to develop it.

“The final version of the conceptual model of access to healthcare that we eventually developed did not emerge until quite late in the review process, and much of the later sampling was directed at testing and purposively challenging the theory as we began to develop it.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

We felt it important that we produced an interpretation of the evidence that could produce new insights and fresh ways of understanding the phenomenon of access, and that the critical voice of our interpretation was maintained throughout the analysis.

“However, we felt it important that we produced an interpretation of the evidence that could produce new insights and fresh ways of understanding the phenomenon of access, and that the “critical voice” of our interpretation was maintained throughout the analysis.”

Probably not a substantial claim: may not pass S3 (load-bearing).

We have analyzed and synthesized only a fraction of all relevant papers in the area of access to healthcare by vulnerable groups.

“We recognize that we have analyzed and synthesized only a fraction of all relevant papers in the area of access to healthcare by vulnerable groups.”

Probably not a substantial claim: may not pass S2 (checkable).

Candidacy is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services.

“It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services.”

• Also stated in: § Access to healthcare · plain

  “Candidacy is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services.”

May combine two claims.

Meta-ethnography has been used solely to synthesise qualitative studies, and has typically been used only with small samples.

“Meta-ethnography, an approach in which there has been recent significant activity and innovation, has similarly been used solely to synthesise qualitative studies, and has typically been used only with small samples [9-11].”

• cites [9] Pound P, Britten N, Morgan M, Yardley L, Pope C, Daker-White G, Campbell R: Resisting medicines: a synthesis of qualitative studies of medicine taking. Soc Sci Med. 2005, 61: 133-155. 10.1016/j.socscimed.2004.11.063. sourceNot checked — no full text of the source
• cites [10] Campbell R, Pound P, Pope C, et al: Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Soc Sci Med. 2003, 56: 671-684. 10.1016/S0277-9536(02)00064-3. sourceNot checked — no full text of the source
• cites [11] Britten N, Campbell R, Pope C, Donovan J, Morgan M, Pill R: Using meta-ethnography to synthesise qualitative research: a worked example. J Health Serv Res Policy. 2002, 7: 209-215. 10.1258/135581902320432732. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Interpretive reviews might construct the field to be known rather differently, seeing the boundaries as more diffuse and ill-defined, as potentially overlapping with other fields, and as shifting as the review progresses.

“Interpretive reviews might construct the field to be known rather differently, seeing the boundaries as more diffuse and ill-defined, as potentially overlapping with other fields, and as shifting as the review progresses.”

Classified as probably not a substantial claim. May combine two claims.

Aggregative reviews have a defining characteristic of a focus on summarising data, and an assumption that the concepts under which those data are to be summarised are largely secure and well specified.

“Their defining characteristics are a focus on summarising data, and an assumption that the concepts (or variables) under which those data are to be summarised are largely secure and well specified.”

• cites [4] Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A: Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy. 2005, 10: 45-53. 10.1258/1355819052801804. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Interpretive reviews see the essential tasks of synthesis as involving both induction and interpretation.

“Interpretive reviews, by contrast, see the essential tasks of synthesis as involving both induction and interpretation.”

• cites [4] Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A: Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy. 2005, 10: 45-53. 10.1258/1355819052801804. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

There is a need to limit the number of papers to be included in an interpretive synthesis for practical reasons, including the time available.

“Nonetheless, there is a need to limit the number of papers to be included in an interpretive synthesis not least for practical reasons, including the time available.”

Classified as probably not a substantial claim.

The product of an interpretive synthesis is theory grounded in the studies included in the review.

“The product of the synthesis is not aggregations of data, but theory grounded in the studies included in the review.”

Classified as probably not a substantial claim.

Conventional systematic review methodology limits the number of papers to be included in a review by having tightly specified inclusion criteria for papers.

“Conventional systematic review methodology limits the number of papers to be included in a review by having tightly specified inclusion criteria for papers.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research.

“By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research.”

Classified as probably not a substantial claim.

Sampling is warranted theoretically, in that the focus in interpretive synthesis is on the development of concepts and theory rather than on exhaustive summary of all data.

“Sampling is also warranted theoretically, in that the focus in interpretive synthesis is on the development of concepts and theory rather than on exhaustive summary of all data.”

May combine two claims.

This theoretical account of access is distinct from models already extant in the literature, and is the result of combining diverse constructs and evidence into a coherent whole.

“This theoretical account of access is distinct from models already extant in the literature, and is the result of combining diverse constructs and evidence into a coherent whole.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Aggregative reviews are concerned with assembling and pooling data, may use techniques such as meta-analysis, and require a basic comparability between phenomena so that the data can be aggregated for analysis.

“Aggregative reviews are concerned with assembling and pooling data, may use techniques such as meta-analysis, and require a basic comparability between phenomena so that the data can be aggregated for analysis.”

• cites [4] Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A: Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy. 2005, 10: 45-53. 10.1258/1355819052801804. sourceNot checked — no full text of the source

May combine two claims.

Few approaches have attempted to apply an interpretive approach to the whole corpus of evidence included in a review, and few have treated the literature they examine as itself an object of scrutiny.

“Few approaches have attempted to apply an interpretive approach to the whole corpus of evidence (regardless of study type) included in a review, and few have treated the literature they examine as itself an object of scrutiny”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

It should in principle be possible and desirable to conduct interpretive syntheses of all forms of evidence, since theory-building need not be based only on one form of evidence.

“Although there is a tendency at present to conduct interpretive synthesis only of qualitative studies, it should in principle be possible and indeed desirable to conduct interpretive syntheses of all forms of evidence, since theory-building need not be based only on one form of evidence.”

Classified as probably not a substantial claim. May combine two claims.

A tightly focused research question allows the parameters of the review to be identified and the study selection criteria to be defined in advance, and in turn limits the amount of evidence required to address the review question.

“A tightly focused research question allows the parameters of the review to be identified and the study selection criteria to be defined in advance, and in turn limits the amount of evidence required to address the review question.”

• cites [12] NHS Centre for Reviews and Dissemination: Undertaking systematic reviews of research on effectiveness: CRD's guidance for those carrying out or commissioning reviews. 2001, York: NHS CRDNot checked yet

  Not checked in the free run.

• cites [13] Alderson P, Green S, Higgins JP: Cochrane Reviewers' Handbook 4.2. 2004, The Cochrane Library, 2Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

A number of authors suggest drawing on the sampling techniques of primary qualitative research, including principles of theoretical sampling and theoretical saturation, when conducting a synthesis of qualitative literature.

“A number of authors [18-20] suggest drawing on the sampling techniques of primary qualitative research, including principles of theoretical sampling and theoretical saturation, when conducting a synthesis of qualitative literature.”

• cites [18] Schreiber RCD, Stern P: Qualitative meta-analysis. In: Completing a qualitative project: details and dialogue. Edited by: Morse JM. 1997, Thousand Oaks, CA: SageNot checked yet

  Not checked in the free run.

• cites [19] Booth A: Cochrane or cock-eyed? How shoul we conduct systematic reviews of qualitative research?. Proceedings of the Qualitative Evidence-based Practice Conference, Taking a Critical Stance. 2001, Coventry University, May 14 2001Not checked yet

  Not checked in the free run.

• cites [20] Paterson B, Thorne S, C C, Jillings C: Meta-study of qualitative health research. 2001, Thousand Oaks: Sage sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable).

Candidacy describes how people's eligibility for healthcare is determined between themselves and health services.

“Candidacy describes how people's eligibility for healthcare is determined between themselves and health services.”

• Also stated in: § Access to healthcare · plain

  “Candidacy describes how people's eligibility for healthcare is determined between themselves and health services.”

Probably not a substantial claim: may not pass S2 (checkable).

Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes.

“Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The approach we used to further specify the review question was highly iterative, modifying the question in response to search results and findings from retrieved items.

“The approach we used to further specify the review question was highly iterative, modifying the question in response to search results and findings from retrieved items.”

Probably not a substantial claim: may not pass S2 (checkable).

A more useful means of understanding access is offered by the synthetic construct of candidacy.

“A more useful means of understanding access is offered by the synthetic construct of candidacy.”

Probably not a substantial claim: may not pass S3 (load-bearing).

An interpretive review will avoid specifying concepts in advance of the synthesis.

“An interpretive review will therefore avoid specifying concepts in advance of the synthesis.”

May combine two claims.

Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually.

“Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention.

“Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

Credibility depends on the quality of the research, its currency, and the robustness of its theoretical base.

“Clearly, credibility depends on the quality of the research, its currency, and the robustness of its theoretical base.”

May combine two claims.

The literature suggests that different groups have identifiable patterns of use of services, but the significance of these is often difficult to interpret.

“The literature suggests that different groups have identifiable patterns of use of services, but the significance of these is often difficult to interpret.”

May combine two claims.

Accomplishing access to healthcare requires considerable work on the part of users, and the amount, difficulty, and complexity of that work may operate as barriers to receipt of care.

“Accomplishing access to healthcare requires considerable work on the part of users, and the amount, difficulty, and complexity of that work may operate as barriers to receipt of care.”

Probably not a substantial claim: may not pass S2 (checkable).

Candidacy functions as a synthetic construct because it is the product of the transformation of the evidence into a new conceptual form.

“Candidacy functions as a synthetic construct because it is the product of the transformation of the evidence into a new conceptual form.”

May combine two claims.

People must be aware of the services on offer, and there has been persistent concern that more deprived people may lack awareness of some services.

“First, people must be aware of the services on offer, and there has been persistent concern that more deprived people may lack awareness of some services [45,46].”

• cites [45] Anderson E, Petersen S, Wailoo M: Health concerns and needs of traveller families. Health Visitor. 1997, 70: 148-150.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [46] House of Commons Health Committee: Inequalities in access to maternity services. Eighth report of session 2002–2003. 2003, London: Stationery OfficeNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

A key feature of this process that distinguishes it from some other current approaches to interpretive synthesis was its aim of being critical: its questioning of the ways in which the literature had constructed the problematics of access, the nature of the assumptions on which it drew, and what has influenced its choice of proposed solutions.

“A key feature of this process that distinguishes it from some other current approaches to interpretive synthesis (and indeed of much primary qualitative research) was its aim of being critical: its questioning of the ways in which the literature had constructed the problematics of access, the nature of the assumptions on which it drew, and what has influenced its choice of proposed solutions.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

The social patterning of perceptions of health and health services, and a lack of alignment between the priorities and competencies of disadvantaged people and the organisation of health services, conspire to create vulnerabilities.

“The social patterning of perceptions of health and health services, and a lack of alignment between the priorities and competencies of disadvantaged people and the organisation of health services, conspire to create vulnerabilities.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

CIS is an approach to review and is not solely a method for synthesis.

“It is important to emphasise, however, that CIS is an approach to review and is not solely a method for synthesis.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Full transparency is not possible because of the creative, interpretive processes involved.

“However, it is important to note that, as with any qualitative analysis, full transparency is not possible because of the creative, interpretive processes involved.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Few published meta-ethnographies have in fact reported a separate refutational synthesis.

“Few published meta-ethnographies have in fact reported a separate refutational synthesis.”

Probably not a substantial claim: may not pass S2 (checkable).

A critical interpretive synthesis is critical in the broader sense of critique rather than the more limited sense of critical appraisal, in which each study is judged against the standards of its type.

“But more generally, a critical interpretive synthesis is critical in the broader sense of critique rather than this more limited sense of critical appraisal, in which each study is judged against the standards of its type.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Critique may involve identification of the research traditions or meta-narratives that have guided particular fields of research as well as critical analysis of particular forms of discourses.

“Critique may involve identification of the research traditions or meta-narratives that have guided particular fields of research [27] as well as critical analysis of particular forms of discourses.”

• cites [27] Greenhalgh T, Robert G, Bate P, Kyriakidou O, Macfarlane F, Peacock R: A systematic review of the literature on diffusion, dissemination and sustainability of innovations in health service delivery. 2004, London: NHS SDO ProgrammeNot checked — no full text of the source

Classified as probably not a substantial claim.

A synthesising argument integrates evidence from across the studies in the review into a coherent theoretical framework comprising a network of constructs and the relationships between them.

“This argument integrates evidence from across the studies in the review into a coherent theoretical framework comprising a network of constructs and the relationships between them.”

Probably not a substantial claim: may not pass S4 (based).

Before our review, RTA had previously only been used for synthesising interpretive research, not a large and diverse body of literature.

“Before our review, RTA had previously only been used for synthesising interpretive research, not a large and diverse body of literature, so this may be one reason why it was unsuccessful for our purposes.”

Probably not a substantial claim: may not pass S2 (checkable).

The appropriate way of conceptualising the output of an LOA synthesis is as a synthesising argument.

“We suggest that the appropriate way of conceptualising the output of an LOA synthesis is as a synthesising argument.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

A focus instead on candidacy would demonstrate the vulnerabilities associated with socio-economic disadvantage, emphasise the highly dynamic, multi-dimensional and contingent character of access, and allow a more insightful interpretation of the evidence on receipt of healthcare.

“Our analysis suggested that a focus instead on candidacy, a synthetic construct that we generated during the course of our analysis, would demonstrate the vulnerabilities associated with socio-economic disadvantage, emphasise the highly dynamic, multi-dimensional and contingent character of access, and allow a more insightful interpretation of the evidence on receipt of healthcare.”

Probably not a substantial claim: may not pass S2 (checkable).

Candidacy describes the ways in which people's eligibility for medical attention and intervention is jointly negotiated between individuals and health services.

“We have defined candidacy as follows: candidacy describes the ways in which people's eligibility for medical attention and intervention is jointly negotiated between individuals and health services.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Synthetic constructs are grounded in the evidence, but result from an interpretation of the whole of that evidence, and allow the possibility of several disparate aspects of a phenomenon being unified in a more useful and explanatory way.

“Synthetic constructs are grounded in the evidence, but result from an interpretation of the whole of that evidence, and allow the possibility of several disparate aspects of a phenomenon being unified in a more useful and explanatory way.”

Classified as probably not a substantial claim.

The aim of critique is to treat the literature as warranting critical scrutiny in its own right.

“Its aim is therefore to treat the literature as warranting critical scrutiny in its own right.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some recent work has suggested that social class variables are generally insignificant in explaining health service use.

“though some recent work has suggested that social class variables are generally insignificant in explaining health service use [30]”

• cites [30] Sutton M, Gravelle H, Leyland A, Morris S, Muirhead M, Noble M, Parkin D, Windmeijer F: Small area study of supply and demand determinants of healthcare resource use and estimation of relative needs for primary care trusts in England. English Department of Health/Advisory Committee on Resource Allocation. 2002Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable).

Access represents a dynamic interplay between simultaneous, iterative and mutually reinforcing processes.

““Access” represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes.”

May combine two claims.

People in disadvantaged groups are more likely to smoke, to be overweight and to have co-morbidities.

“People in disadvantaged groups are more likely to smoke, to be overweight and to have co-morbidities, and professional perceptions of the cultural and health capital required to convert a unit of health provision into a given unit of health gain may function as barriers to healthcare [34].”

• cites [34] Watt G: The inverse care law today. Lancet. 2002, 360: 252-254. 10.1016/S0140-6736(02)09466-7. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Our experience suggests that while attention to scientific quality is required, more generally the emphasis should be on critique rather than critical appraisal, and an ongoing critical orientation to the material examined and to emerging theoretical ideas.

“Our experience suggests that while attention to scientific quality is required, more generally the emphasis should be on critique rather than critical appraisal, and an ongoing critical orientation to the material examined and to emerging theoretical ideas.”

Classified as probably not a substantial claim.

In CIS, processes of question formulation, searching, selection, data extraction, critique and synthesis are characterised as iterative, interactive, dynamic and recursive rather than as fixed procedures to be accomplished in a pre-defined sequence.

“Processes of question formulation, searching, selection, data extraction, critique and synthesis are characterised as iterative, interactive, dynamic and recursive rather than as fixed procedures to be accomplished in a pre-defined sequence.”

Classified as probably not a substantial claim.

Independent of the severity of the disease, some GPs are more likely to refer the economically active and those with dependants.

“Goddard and Smith [49] summarise evidence suggesting that independent of the severity of the disease, some GPs are more likely to refer the economically active and those with dependants.”

• cites [49] Goddard M, Smith P: Equity of access to health care. 1998, York: University of YorkNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be much better understood, and more appropriate recommendations made for policy, practice and future research.

“By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be much better understood, and more appropriate recommendations made for policy, practice and future research.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Realist synthesis includes diverse forms of evidence and is oriented towards theory evaluation, in particular by focusing on theories of change.

“Realist synthesis [68], which does include diverse forms of evidence, is oriented towards theory evaluation, in particular by focusing on theories of change.”

• cites [68] Pawson R, Greenhalgh T, Harvey G, Walshe K: Realist review-a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005, 10 (Suppl 1): 21-34. 10.1258/1355819054308530. sourceNot checked — no full text of the source

May combine two claims.

There is rarely an attempt in current approaches to reconceptualise the phenomenon of interest, to provide a more sweeping critique of the ways in which the literature in the area have chosen to represent it, or to question the epistemological and normative assumptions of the literature.

“There is rarely an attempt to reconceptualise the phenomenon of interest, to provide a more sweeping critique of the ways in which the literature in the area have chosen to represent it, or to question the epistemological and normative assumptions of the literature.”

Classified as probably not a substantial claim.

Clinical decisions may rest on often implicit social criteria about which patients ought to receive care.

“As Hughes and Griffiths [61] identify, clinical decisions may rest on often implicit social criteria about which patients “ought” to receive care”

• cites [61] Hughes D, Griffiths L: Ruling in and Ruling out: two approaches to the micro-rationing of health care. Soc Sci Med. 1997, 44: 589-599. 10.1016/S0277-9536(96)00207-9. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S4 (based).

Conventional systematic review methodology sets great store by the reproducibility of its protocols and findings.

“Conventional systematic review methodology sets great store by the reproducibility of its protocols and findings.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Middle class people may be more adept at using their voice to demand better and extensive services, being more articulate, more confident, and more persistent, while people from lower class backgrounds are less verbally active.

“Dixon et al [57] and, in the US, Cooper and Roter [58] suggest that middle class people may be more adept at using their “voice” to demand better and extensive services: they may be more articulate, more confident, and more persistent, while people from lower class backgrounds are less verbally active.”

• cites [57] Dixon A, Le Grand J, Henderson J, Murray R, Poteliakhoff E: Is the NHS equitable? A review of the evidence. London. LSE Health and Social Care. 2003Not checked yet

  Not checked in the free run.

• cites [58] Cooper L, Roter D: Patient-provider communication: the effect of race and ethnicity on process and outcomes of healthcare. Unequal treatment: confronting racial and ethnic disparities in health care. Edited by: Smedley BD, Stith AY, Nelson AR. 2003, Washington DC: National Academies PressNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

In this conceptual model of access to healthcare, health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention.

“In this conceptual model of access to healthcare, health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention.”

Probably not a substantial claim: may not pass S3 (load-bearing).

People with low incomes may feel alienated by the power relations that often characterise encounters with professionals.

“Sword [56] points out that people with low incomes may feel alienated by the power relations that often characterise encounters with professionals.”

• cites [56] Sword W: A socio-ecological approach to understanding barriers to prenatal care for women of low income. J Adv Nurs. 1999, 29: 1170-1177. 10.1046/j.1365-2648.1999.00986.x. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Demands from health policy-makers and managers for syntheses of evidence that are useful, rigorous and relevant are fuelling interest in the development of methods that can allow the integration of diverse types of evidence.

“Demands from health policy-makers and managers for syntheses of evidence that are useful, rigorous and relevant are fuelling interest in the development of methods that can allow the integration of diverse types of evidence [66].”

• cites [66] Sheldon TA: Making evidence synthesis more useful for management and policy-making. J Health Serv Res Policy. 2005, 10 (Suppl 1): 1-5. 10.1258/1355819054308521. sourceNot checked — no full text of the source

May combine two claims.

More deprived people are at risk in situations of asserting candidacy because they may be less used to or less able to provide coherent abstracted explanations of need, and may feel intimidated by their social distance from health professionals.

“More deprived people are at risk in these situations: they may be less used to or less able to provide coherent abstracted explanations of need, and may feel intimidated by their social distance from health professionals.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

CIS emphasises a need for constant reflexivity to inform the emerging theoretical notions, and guides the sampling of articles.

“Further, it emphasises a need for constant reflexivity to inform the emerging theoretical notions, and guides the sampling of articles.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Appearing at health services involves people in asserting a claim to candidacy for medical attention or intervention.

“Appearing at health services involves people in asserting a claim to candidacy for medical attention or intervention.”

Classified as probably not a substantial claim.

Making a claim to candidacy clearly involves work that requires a set of competencies, including the ability to formulate and articulate the issue for which help is being sought, and the ability to present credibly.

“Whatever the nature of the claim, making it clearly involves work that requires a set of competencies, including the ability to formulate and articulate the issue for which help is being sought, and the ability to present credibly.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Although our review focused on the UK, the construct of candidacy is transferable, and has useful explanatory value in other contexts.

“Although our review focused on the UK, we suggest that the construct of candidacy is transferable, and has useful explanatory value in other contexts.”

Probably not a substantial claim: may not pass S2 (checkable).

In treating the literature as an object of scrutiny in its own right, CIS problematises the literature in ways that are quite distinctive from most current approaches to literature reviewing.

“In treating the literature as an object of scrutiny in its own right, CIS problematises the literature in ways that are quite distinctive from most current approaches to literature reviewing.”

Classified as probably not a substantial claim.

In addition to its explicit orientation towards theory generation, what most distinguishes CIS from conventional systematic review methods is its rejection of a stage approach to review.

“In addition to its explicit orientation towards theory generation, perhaps what most distinguishes CIS from conventional systematic review methods is its rejection of a “stage” approach to review.”

Classified as probably not a substantial claim. May combine two claims.

CIS emphasises the need for theoretical categories to be generated from the available evidence and for those categories to be submitted to rigorous scrutiny as the review progresses.

“CIS emphasises the need for theoretical categories to be generated from the available evidence and for those categories to be submitted to rigorous scrutiny as the review progresses.”

Classified as probably not a substantial claim.

CIS recognises the need for flexibility in the conduct of review.

“CIS recognises the need for flexibility in the conduct of review”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Formal data extraction may be an unnecessarily constraining and burdensome process.

“Formal data extraction may also be an unnecessarily constraining and burdensome process.”

Probably not a substantial claim: may not pass S2 (checkable).

Many current approaches to review fail to be sufficiently critical, in the sense of offering a critique.

“More generally, many current approaches fail to be sufficiently critical, in the sense of offering a critique.”

Classified as probably not a substantial claim. May combine two claims.

Although CIS demands attention to flaws in study design, execution and reporting in judgements of the quality of individual papers, its critical approach goes beyond standard approaches.

“Although CIS demands attention to flaws in study design, execution and reporting in our judgements of the quality of individual papers, its critical approach goes beyond standard approaches.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A common strategy in conventional systematic review is to limit the study types to be included; this strategy also might result in only a proportion of the potentially relevant literature being synthesised.

“However, a common strategy in conventional systematic review is to limit the study types to be included; this strategy also might result in only a proportion of the potentially relevant literature being synthesised.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

It would certainly have been possible to produce an account of the evidence that was more reproducible.

“It would certainly have been possible to produce an account of the evidence that was more reproducible.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

The methodology termed critical interpretive synthesis offers the potential for insight, vividness, illumination, and reconceptualisation of research questions, particularly in challenging areas such as access to healthcare.

“We believe that this methodology offers the potential for insight, vividness, illumination, and reconceptualisation of research questions, particularly in challenging areas such as access to healthcare, and look forward to further evaluations of its application.”

• AssumptionRests on an assumption: Access to healthcare by vulnerable groups is a challenging area for interpretive review.

Probably not a substantial claim: may not pass S2 (checkable).

Simply to have produced a thematic summary of what the literature was saying would have run the risk of accepting that the accounts offered in the evidence-base were the only valid way of understanding the phenomenon of access to healthcare by vulnerable groups.

“Simply to have produced a thematic summary of what the literature was saying would have run the risk of accepting that the accounts offered in the evidence-base were the only valid way of understanding the phenomenon of access to healthcare by vulnerable groups.”

Probably not a substantial claim: may not pass S2 (checkable).

Our decision not to commit to a particular view of what access might be and how it should be assessed at the outset of the project was critical to our subsequent development of a more satisfactory understanding of access.

“Our decision not to commit to a particular view of what access might be and how it should be assessed at the outset of the project was critical to our subsequent development of a more satisfactory understanding of access.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Our decision not to limit the focus of the review at the outset, and our subsequent sampling strategies, were well justified.

“On balance, faced with a large and amorphous body of evidence in an area such as access to healthcare, and given the aims of an interpretive synthesis, we feel that our decision not to limit the focus of the review at the outset, and our subsequent sampling strategies, were well justified.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

This dilemma between the answerable question and the meaningful question has received little attention, but it underpins key tensions between the two ends of the academic/pragmatic systematic review spectrum.

“This dilemma between the “answerable” question and the “meaningful” question has received little attention, but it underpins key tensions between the two ends of the academic/pragmatic systematic review spectrum.”

Probably not a substantial claim: may not pass S3 (load-bearing).

It is possible that another team using the same approach could have come up with a different sample, because, particularly in the later stages of our review, our sampling was highly intuitive and guided by the emerging theory.

“While we have described our methods for sampling as purposive, it is possible that another team using the same approach could have come up with a different sample, because, particularly in the later stages of our review, our sampling was highly intuitive and guided by the emerging theory.”

Probably not a substantial claim: may not pass S2 (checkable).

Conducting interpretive reviews in challenging areas where there is a large body of diverse evidence demands an approach that can draw on the strengths of conventional systematic review methodology and on the recent advances in methods for interpretive synthesis.

“Conducting interpretive reviews in challenging areas where there is a large body of diverse evidence demands an approach that can draw on the strengths of conventional systematic review methodology and on the recent advances in methods for interpretive synthesis.”

• AssumptionRests on an assumption: Access to healthcare by vulnerable groups is a challenging area for interpretive review.

May combine two claims.

Such forms of searching and sampling do not lend themselves easily to reproducibility or indeed auditability.

“Again, such forms of searching and sampling do not lend themselves easily to reproducibility or indeed auditability.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The production of a synthesizing argument, as an interpretive process, produces one privileged reading of the evidence, and, as the product of an authorial voice, it cannot be defended as an inherently reproducible process or product.

“Clearly, the production of a synthesizing argument, as an interpretive process, produces one privileged reading of the evidence, and, as the product of an authorial voice, it cannot be defended as an inherently reproducible process or product.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Our analysis can be defended on the grounds that it is demonstrably grounded in the evidence; that it is plausible; that it offers insights that are consistent with the available evidence; and that it can generate testable hypotheses and empirically valuable questions for future research.

“We would suggest, however, that our analysis can be defended on the grounds that it is demonstrably grounded in the evidence; that it is plausible; that it offers insights that are consistent with the available evidence; and that it can generate testable hypotheses and empirically valuable questions for future research.”